Caries & prevention Flashcards
What are key info you need to find out in medical hx?
Vaccinations up to date?
Any childhood disease? i.e. chickenpox – as it affects development causing MIH/hypoplasia
Birth complications (normal delivery, preterm, overdue, C-section – this can also affect tooth development)
Allergies (incl milk, clove oil)
Run through all systems (incl asthma & if hospitalised)
Medications?
What are the key info you need to find out in dental hx?
Brushing habits? (2x a day)
Supervised tooth brushing? (up to age 7)
F use?
Part of F program at school?
Any px dental tx? (indicates compliance)
Habits? – digit sucking, dummy, or milk bottle at night
24hr diet
What are the key info you need to find out in social hx?
Who lives at home + takes care of child?
If known to social service?
If attends school?
Any sibblings + do they have similar dental problems
Who has legal parental responsibility? (4)
Biological mother
Unmarried father on birth certificate
Biological father married to mother at time of birth
Legal appointed guardian, see evidence of court order
Legal age of child
<18 years old
Children under the age of 16 can give consent if deemed “Gillick-competent”
If a child attends with someone who does not have parental responsibility, you should try to contact the person who has PR when deciding on a tx plan
What would you do when in an emergency (e.g., trauma/avulsion) where time is of the essence & cannot get hold of PR and the child is not Gillick competent?
Act in the patient’s best interest
Can always call indemnity too if time permitting & unsure
List 7 non-pharmacological interventions
(2 controls, DD, MNP)
Enhanced pt control (e.g. stop signs)
Voice control (age appropriate)
Desensitisation (graded exposure)
Distraction (e.g. w sounds or screen)
Modelling (e.g. w parent)
Non-verbal communication (e.g. smiling)
Positive reinforcement (e.g. ‘well done’, stickers)
What are pharmacological interventions?
IHS
IVS (if older than 12)
GA
Eruption dates of permanent teeth
+/- 18 months:
6 yr old: all 6s & lower 1s
7 yr old: upper 1s & lower 2s
8 yr old: upper 2s
11 yr old: lower 3s, all 4s
12 yr old: upper 3s, all 5s & 7s
18-22 yr old: 8s
Exfoliation dates of deciduous teeth
+/- 18 months
A & B: 7 yrs
C: 11
D: upper 10, lower 9-12
E: 11
Special investigations in paeds (5)
- Plaque free score
- Diet analysis
- TTPal (check presence of buccal swelling + sinus )
- Simplified BPE (7+ years, check all 6s, LL1 & UR1 using scores 0,1,2)
- Radiographs:
BWs: assess presence & depth of caries
PA: assess PA path, trauma & parallax for ortho)
OPG: unable to tolerate BWs, mixed dentition, >1 quad needs assessing)
NICE recalls for paeds
NICE:
High risk = 3m
Medium risk = 6m
Low risk: 12m
AAPD guidelines used for caries risk assessment
Radiographic recall for paeds BWs
FGDP:
High risk: 6m
Medium risk: 12m
Low risk: 12-18m
List OHI for paeds (5)
Brush 2x daily for 2 mins
Spit, do not rinse
Reduce frequency & amount of sugary food/drink (4 acid attacks max/day)
Investigate diet w/ “Eatwell Guide” (diet analysis (24hr recall/sheet + advice)
Supervised toothbrushing for up to 7yrs old (also, demonstrate toothbrushing too)
FV application rules
FV conc = 2.26% (22,600 ppmF)
If 3+ yrs:
Normal risk: FV <2 a year
High risk: FV >2 a year
No FV if <3 yrs
Amount:
deciduous only = 0.25ml
mixed dentition = 0.4ml
permanent dentition = 0.5ml
DBOH rules for toothpaste & mouth wash
TOOTHPASTE RULES:
0-3 yr + normal = 1000ppmF (smear)
0-3 yr + high risk = 1350-1500ppmF (smear)
3+ yr + normal = 1350-1500ppmF (pea sized)
10+ yr + high risk =
prescribe 2800ppmF (Duraphat)
16+ yr + high risk = prescribe 5000ppmF (duraphat)
MOUTHRINSE:
From 8+ yrs, prescribe 0.05% NaF m/w @ different time to brushing
List your prevention & stabilisation tx plan
- thorough OHI & demonstrate brushing
- diet advice & eat well guide
- Plaque free score
- Simplified BPE
- Supragingival PMPR
- TFV (>2x/year if high risk)
- FS (all permanent 6s, cingulum pits of 2s then deciduous)
- prescribe m/w or duraphat depending on age
- Non-specific cavity control (NSCC - ‘site specific prevention’, remove overhanging enamel to make tooth cleansable, no caries removal, active prevention)
What are the contraindications of SSC?
- Nickle allergy
- no clear band of dentine / caries into pulp
- abscess / sinus present
- close to exfoliation (>6 months / mobile)
FRANKL scoring system
FRANKL score:
1 = definitely positive
2 = positive
3 = negative (reluctant for tx & uncooperative)
4 = definitely negative (refusal of tx & crying)
Management of 1 large lesion or small 2 sites in deciduous tooth w clear band of dentine
SDCEP:
SSC hall technique (if no contraindications)
If child is cooperative: LA, drill & comp resto
Management of caries into D3 w signs of irreversible pulpitis (no pulp involvement on rad)
SDCEP:
Caries removal,
indirect pulp cap (setting CaOH) to encourage tertiary dentine formation
Composite (or GIC as temp) to finish
Management of irreversible pulpitis (caries into pulp w no signs of bifurcation or radicular involvement)
SDCEP:
LA & Rubber dam
Pulpotomy (removal of coronal pulp, FeSO4 15.5% w microbrush for 15 secs to stop bleeding, rinse w saline)
IRM to fill pulp chamber (ZnO Eugenol)
SSC for definitive resto on top
Management of irreversible pulpitis w no bifurcation involvement BUT has radicular pulp involvement
Pulpectomy
Management of irreversible pulpitis w bifurcation & radicular involvement, signs of infection, root resorption, unrestorable tooth/grossly carious
XLA
During emergency apt:
- radiograph
- hand excavate caries, dress w IRM & temporise w GIC (plan for XLA later)
